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Benzodiazepine use may increase pneumonia risk

Results from a meta-analysis revealed that current or recent benzodiazepine use was linked to an increased risk for pneumonia.

“The precise mechanism of potential risk is unknown, but several biological mechanisms have been proposed to explain a possible relationship between [benzodiazepine] use and the risk of pneumonia, including suppression of the immune system and relaxation of esophageal sphincter that could increase pneumonia risk,” Guoqing Sun, PhD, from the department of psychiatry, The Seventh Hospital of Hangzhou, China, and colleagues wrote.

The researchers conducted a systematic literature review and meta-analysis of observational studies to examine the relationship between benzodiazepine exposure and the later development of pneumonia in the general population. Studies were included in the analysis if they compared pneumonia development among those receiving benzodiazepine vs. those without treatment.

Sun and colleagues also conducted subgroup analyses based on study design type, age group (younger or older than 65 years), type of benzodiazepine, benzodiazepine half-life, drug exposure duration and methodological quality of study. Exposure to benzodiazepine was divided into three windows: current (use within the past 30 days), recent (within 31-90 days) and past use.

The meta-analysis included 10 studies involving more than 120,000 pneumonia cases. After pooling the estimates, analysis revealed that benzodiazepine users were more likely to develop pneumonia than nonusers (OR = 1.25; 95% CI, 1.091.44). Heterogeneity was high across the studies (I² = 97%).

Benzodiazepine exposure was consistently linked to a greater risk for pneumonia in the subgroup analyses. The highest risk for pneumonia was observed in current short-acting benzodiazepine users (OR = 2.06; 95% CI, 1.353.13), according to further subgroup analyses. Analysis also showed an increased pneumonia risk for current (OR = 1.4; 95% CI, 1.221.6) and recent (OR = 1.38; 95% CI, 1.061.8) benzodiazepine users, but not for past users (OR = 1.11; 95% CI, 0.961.27).

Sun and colleagues explained that because antipsychotics — which also increase risk for pneumonia — are commonly prescribed concurrently with benzodiazepines for treating mental disorders, future research should examine a psychiatric, not just general, population.

“Although benzodiazepine use is associated with a small increased risk of pneumonia, the population-level impact of benzodiazepine-associated pneumonia is likely to be substantial given the large number of users,” the researchers wrote. “Clinicians should ensure that benzodiazepines are prescribed only for patients with a clear indication and should be cautious when prescribing benzodiazepines to patients who have an underlying increased pneumonia risk.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.